How does one choose which treatment for cosmetic body sculpting is most appropriate? Is a reduction in fat needed or tightening of skin, or both?  Is fat loss needed in a pinchable site or a larger area?  Is the skin sagging or loose? Does muscle need to be toned or built? How much downtime is acceptable? How much time before treatments results can be expected? 

Body sculpting can be broken down into two categories:  

  • Surgical  
  • Non-surgical 

Surgical is the most invasive but also most able to alter appearance. A common example of this is liposuction.  All true surgeries have some form of recovery and down time.  Risks include but are not limited to anesthesia, bleeding, infection, scaring, and chronic pain. Although the changes in the amount of fat can be more than other less invasive procedures the downtime and recovery and potential for adverse events is much higher. The fat targeted with liposuction is the pinchable, or subcutaneous, fat. The deeper and worse for your health fat called visceral fat does not get removed.  There is no muscle improvement with these surgeries, in fact the recovery period can often result in a reduction in muscle. Reduced overall muscle can lead to reduced metabolism and hinder maintenance of lost fat. In some patients this is the best option for weight loss and again should be discussed with your doctor to weigh the pros and cons. 

Non-surgical lipolysis (lipolysis = fat destroying) and has many varieties. These are typically geared towards stubborn pockets of fat and used on people who do not want any downtime or the added risk that go along with surgery. Non-surgical body sculpting procedures are not intended to be weight loss solutions. Ideal candidates are those who are close to their desired weight and want to eliminate stubborn pockets of fat that are resistant to diet and exercise. With most body sculpting procedures your body mass index (BMI= weight/height^2) shouldn’t be much over 30.  Although you can do the procedures with a greater BMI the best results are for those who are just a little overweight or at the ideal weight. 

Most non-surgical body sculpting  treatments are based on one or more of the following:  

1) Cryolipolysis commonly known as CoolSculpting TM or controlled cooling uses freezing temperatures to target and destroy fat cells. The cold freezes the fat cells but does not permanently harm the surrounding tissues. The injured fat cells are then removed by the body over weeks through the lymphatics.  The device has one applicator which can treat neck, arms, abdomen, back, flanks, butt, and thighs but at separate times unless the provider has two devices present.  Each treatment takes about 60 minutes and 3-5 treatments are typically required per area. Full results take about 4 months to appear. There is no downtime. During the procedure patients report a mild to moderate burning or freezing feeling. Downsides: One may see shelving wherein there’s an indentation at the treated area next to the area not treated.  Also numbness can occur with treatments but this nearly always resolves.  Lastly, no skin tightening or muscle building occurs with this treatment. 

2) Laser lipolysis commonly known as WarmSculpting by SculpSure TM uses controlled heating from a laser that is a specific wavelength that only damages fat cells. It has a cooling mechanism to protect the skin. The Sessions take 24 minutes and 3-5 treatments are typically required per area but this device has 4 applicators which can be used at the same time. It also can treat neck, arms, abdomen, back, flanks, butt and thighs. It is about 4 months for the treatment effects to be fully noticed.  During treatment sessions patients describe pinching, warmth that comes in waves between cooling. There is no downtime. Because heating is used there is a mild skin tightening effect but not as great as radiofrequency mentioned later. The downside is no muscle building occurs and treated areas can develop lumps if not massaged regularly the first 5 days. These clumps always resolve but they represent slow to be removed fat that can delay results.  

3) Radiofrequency technology has the most variety of devices on the market.  These use heating to both destroy fat cells and tighten skin. Make sure that if this method is chosen that the provider’s device has a temperature sensor.  Some radiofrequency devices without sensors have the potential to either get too hot and burn the skin or not get hot enough which does not yield good cosmetic results. Applicators vary per device and can treat many body parts including the face.  Treatments are described as similar to a warm stone massage. Sessions last about an hour and 3-6 sessions are required.  Final results are usually present in 4 months. Mild swelling after each session gives a transient improvement lasting several days. This is a great treatment right before the beach or pool party. Downside: many devices offer inconsistent results due to lack of temperature sensors. Depth of penetration can be less than other treatments. There is no muscle building in this process. 

4) Injection lipolysis is most commonly known for its under the chin injections with Kybella^TM.  This chemical, as well as similar chemicals, break down fat where they are injected.  This is done less often in the modern area given other options available.  There are providers using it to digest fat in other areas of the body.  The downside is that It does have some down time of a week but this is less than surgery. Swelling and discoloration are very common with this procedure but resolve after a couple of weeks in most cases. Treatments including numbing are usually about 30 minutes long and described as a moderate to severe burning pain. Repeat treatments are required. Typically, treatments are done at 2 month intervals. Again, full results usually take about 4 months.  

5) Electro-magnetically induced muscle contractions come in a few varieties the most commonly known are HIFEM (= high intensity focused electromagnetic) contractions and MMS magnetic muscle stimulation which results in larger and stronger muscles.  Bigger muscles in certain areas enhance our shape. Common devices with these technologies are Emsulpt^TM and Cooltone^TM respectively. These allow for muscle toning without exercising. While they are causing contractions of the muscles the muscle is burning the surrounding fat. These do decrease some of the fat in and around the muscle. The treatments are equivalent to 20,000 contractions.  Treatment time is 30 minutess and 4 treatments are recommended for full desired result. Results are most apparent in 4 months. There is no downtime, there is no pain or discomfort.  Downside: you cannot use this device if you have any implantable metal like a pacemaker or defibrillator. This also does not offer as much fat reduction as some of the other above modalities. 

6) Emsculpt Neo^TM  is the only one of the body sculpting devices to combine both electro-magnetically induced muscle contractions (HIFEM) with a temperature- controlled radiofrequency treatment (#’s 3 and 5 above). Combining these modalities allows for simultaneous skin tightening, fat destruction, and more effective muscle building as compared to performing these treatments separately. It is equivalent to going to the gym daily for 14 weeks of high intensity interval training (HIIT) on the targeted area. Patients describe this as a mild to moderate warmth along with frequent muscle contractions.  Sessions are 30 minutes each and a total of 4 treatments roughly one week apart are recommended for a full desired result. Final results are seen at 4 months. It makes sense that this improvement in percentage of muscle growth improves metabolism allowing for further improvement in reducing total body fat percentage. The added muscle can improve strength and stamina.  This combination has been shown to reduce not only subcutaneous fat, which the other body contouring devices are limited to but also reduces the more detrimental and inflammatory visceral fat. This has the potential to reduce illness and chronic disease. Downside: implanted metallic devices are contraindicated. 

Each body is different and the best way to find out whether you are a suitable candidate for a body sculpting treatment is by speaking to a physician who is well versed on the topic. All of these treatments work best with appropriate diet and exercise but now there are options that do not involve eating or going to the gym. It is important to consider downtime and  treatment time, as well as the time for desired effect to occur, desire for removing pockets of fat, reducing overall waist circumference, desire or need to build muscle, and/or skin tightening. 

By Alethia Pantazis, MD, February 2021